Job Description

GENERAL PURPOSE/SCOPE:

The Enrollment Specialist conducts outreach to referred applicants upon receipt of a referral and responds to inbound phone calls from prospective members. The Intake/Enrollment Specialist pre-determines the applicant eligibility following the criteria guidelines. Verifying E-Paces and UAS.  The Intake/Enrollment Specialist will schedule the applicant’s initial assessment with the field assessment nurse and place the appointment on the assigned field assessment nurse calendar in outlook. The Intake/Enrollment Specialist will conduct several follow up efforts to ensure the applicant’s enrollment is processed accordingly.  Required to document all applicant contact and outcomes. Maintain strong knowledge of the products, departmental workflows/processes, and applicable state and federal regulations. Required to meet and or exceed the company’s performance metrics. Adhere to company policies and procedures. Maintain compliance while handling applicant/member/participant information/documentation etc. 

RESPONSIBILITIES INCLUDE:

• Conduct outreach to referred applicants upon receipt of referrals
• Answer inbound phone calls from prospective members inquiring about enrolling with Integra
• Pre-determine applicant eligibility following the criteria guidelines. i.e. verify e-paces and UAS
• Schedule initial assessments with the field assessment nurse
• Enter initial assessments scheduled on the field assessment nurse calendar in outlook
• Review enrollment documentation to ensure completed accurately prior to processing the enrollment to ensure quality assurance standards are met. i.e. initials, signatures, and date are noted on the enrollment form.
• Ensure the Field assessment nurse uploads all required enrollment documentation in the member record in Carecompass.
• Follow up with the Field assessment nurse when and if necessary regarding documentation and or outcome of the initial assessment
• Follow up efforts to ensure applicants are processed timely and accurately
• Document all follow up efforts in Care Compass and update status’s in the Intake log spreadsheet
• Conduct plan to plan warm transfers to Maximus in a timely manner and update the status in the warm transfer log.
• Maintain compliance while handling applicant/member/participant information and or documentation
• Meet and or exceed the company’s performance metric’s

QUALIFICATIONS:

• Bachelor’s Degree preferred
• Minimum of 1 year of experience in the Managed Care Industry ideally in Managed Long Term Care some knowledge of Medicaid and Medicare.

SKILLS/ABILITIES:

• Strong communication, organizational and multitasking

• Must be flexible to work different shifts.

• Demonstrate a passion for excellence with respect to treating and caring for customers.

• Ability to identify customer needs and clearly communicate products and services offered.

• Bilingual verbal competency in English/Spanish OR Bengali

• Proficiency with Microsoft office (Outlook, Word, Excel)

Integra is an Equal Opportunity Employer and Prohibits Discrimination and Harassment of Any Kind.  Integra is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Integra are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, sex, sexual orientation, gender identity, national origin, veteran or disability status, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. Integra will not tolerate discrimination or harassment based on any of these characteristics. Integra encourages applicants of all ages.

If this opportunity sounds exciting and challenging to you, please click “Apply” now!

Company Description

Integra MLTC, Inc. (“Integra”) is a Medicaid Managed Long Term Care Plan that serves Medicaid beneficiaries in need of long term supportive services to help them live in their home and community. Integra serves frail seniors and adults requiring long term care services, aged 18 and over. Integra’s service areas include the five boroughs of New York, Nassau, Suffolk, and Westchester. Mission: To assist frail elderly and adults who require long term care services to live safely and independently in their home for as long as possible while maintaining their health and wellbeing. Vision: Integra aspires to be the preferred plan of choice for individuals in need of quality long term care. By consistently delivering best care and services, they want to be the most trusted plan in the metropolitan New York area.